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Pennsylvania rates for HCPCS 50750

Ureterocalycostomy, anastomosis of ureter to renal calyx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $5,754.40 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,230.27 / $2,511.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,479.11 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,445.44 / $2,238.72
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $1,737.80
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $2,238.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,265.80 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,445.44 / $3,311.31
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,290.87
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $2,398.83
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $1,412.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,148.15 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $2,344.23